A sexual assault can create an urgent to-do list: To start, protect the victim from future assault, contact law enforcement, prevent possible pregnancy and check for sexually transmitted infections.
But even if these stressful short-term concerns are resolved, many people continue to struggle with the lingering effects of sexual abuse or assault for months or years.
Shweta Kapoor, M.D., Ph.D., a Mayo Clinic psychiatrist with expertise in complex trauma, has witnessed the long-term impacts of sexual violence on emotional and mental health. She explains how sexual violence can lead to trouble regulating emotions, a loss of sense of self, dissociation, post-traumatic stress disorder and other mental health conditions.
Prevalence of sexual abuse
Experiencing sexual assault and childhood sexual abuse is common, especially among girls and women.
Racial and ethnic minorities and LGBTQI+ individuals also are at higher risk of sexual violence. These groups, along with immigrants and undocumented individuals, also may find it harder to receive care after victimization because of language and cultural barriers, lack of insurance, location of resources, and lack of services directed toward populations like queer men.
Sexual assault can be defined as sexual activity without consent. That could be rape or attempted rape, anal sex, oral sex, fondling or groping. Sexual abuse of children includes these forms of sexual assault as well as abuse without actual touch — like exposing oneself to a child, showing a child pornography or having sexual conversations.
Sexual abuse and childhood sexual abuse statistics
It’s hard to know exactly how common sexual assault and childhood sexual abuse are, for the simple reason that many children and adults don’t report the abuse.
Still, there are some estimates about how often these abuses happen:
- A Centers for Disease Control and Prevention (CDC) survey found that 27% of women and 4% of men reported being victims of rape or attempted rape.
- That same CDC survey found that almost half of women and almost a quarter of men have received unwanted sexual contact — which means there was touching but not penetration.
- In the U.S., it’s estimated that over 60,000 children are sexually abused each year.
When sexual abuse or assault happens repeatedly, it can lead to complex trauma.
Lingering effects of sexual trauma
There are many possible physical, sexual, emotional and mental effects of sexual trauma. But people who’ve been traumatized may not necessarily make the connection between their history and their current struggles.
“A lot of times if you ask them, ‘Have you ever experienced trauma in your life?’ they probably don’t even recognize it. Because trauma has been an indelible part of their life since childhood. They don’t know that it’s trauma, they think this is normal and happens to everyone,” Dr. Kapoor says.
As a psychiatrist, she asks questions like, “Are there things that your mind keeps going back to? Are there things you keep dreaming about?”
Part of her job is to help people understand their life stories and how what happened to them affects who they are today. Sexual trauma may contribute to a loss of sense of self, emotional dysregulation, or mental health problems such as obsessive-compulsive disorder or borderline personality disorder.
Loss of sense of self
Our families play a major role in the formation of our identities. But all too often, the abuser of a child is a close relative or someone they are familiar with. (1) There’s often simultaneous emotional abuse, with the perpetrator shifting blame to the victim, Dr. Kapoor says.
“Perpetrators may say things like, ‘I’m not doing anything bad to you, you’re just making it out to be sexual. This is how I love you, that’s why I’m touching you,'” says Dr. Kapoor. “Imagine getting those messages from people who you really trust. Over time, you start to believe that you’re making it up and start losing your sense of self and self-worth.”
If you’re a parent, you know that self-soothing is a life-changing (and sleep-saving) skill for infants and toddlers. You may not realize that it goes way beyond cuddling a stuffed animal or preventing a tantrum in the grocery store — it can be important for coping with adult life as well.
When life delivers frustrations, disappointments, sleep deprivation and stress, many people are ultimately able to cope by using self-soothing skills they learned as a child. They may still snap at their partner or kids or have the occasional sob in the shower, but by and large, they self-soothe, or regulate, their emotions.
Some people who have experienced repeated sexual abuse aren’t able to regulate their emotions well. Even something seemingly very small — like a minor frustration, loss or innocuous comment — can cause an emotional explosion. This is often called emotional dysregulation.
“Due to their experience of early life adversity, they have much lower distress tolerance,” says Dr. Kapoor. “If anything stressful comes up … they can go from zero to 100 in a second.”
A child who has been sexually abused is deprived of developing healthy responses to stress and trauma later in life, she says.
Depersonalization and derealization
Some people who have experienced sexual assault or abuse may sometimes feel like the people and world around them are unreal, foggy or dreamlike — a phenomenon known as derealization. Or their actions and thoughts seem to be happening to another person or like they’re watching them from the outside — known as depersonalization. Both are forms of dissociation.
“It’s your brain’s way of protecting you when you get triggered,” says Dr. Kapoor. “If it’s too overwhelming, your brain steps in to protect you, leading to dissociative experiences.”
Dissociation can be debilitating, impairing an individual‘s psychological quality of life and sense of safety, she says.
Other mental health diagnoses
Experiencing abuse or assault also can contribute to other mental health disorders such as anxiety, depression and obsessive-compulsive disorder (OCD). Some people may experience post-traumatic stress disorder (PTSD).
Traumatic life events are a possible risk factor for OCD, a disorder marked by unwanted thoughts, fears and repetitive behaviors meant to allay those thoughts and fears. People with OCD may spend hours each day caught in obsessions and compulsive behaviors.
“When you’re sexually abused as a child, an adolescent or even as an adult, it’s a feeling of being out of control, right?” Dr. Kapoor says. “OCD is very much like you’re now taking control of your life, but it goes too far. It becomes impairing for you, but you can’t stop.”
Are there common personality traits in adults with a history of sexual abuse?
Additionally, Dr. Kapoor says women who are victims of abuse and experience trauma reactions, including severe emotional dysregulation, often get diagnosed with borderline personality disorder — a terminology she believes further stigmatizes the child sexual abuse survivor.
“Once you get labeled with borderline, your trauma reactions are seen as a personality flaw, something you should fix, and not due to something that happened to you,” she says.
While there are common potential consequences of sexual abuse, Dr. Kapoor says that trauma reactions in context of childhood sexual abuse are not personality flaws.
Dr. Kapoor emphasizes: “It’s something that happened to you. It’s a part of your life story but it is not you.”
How can sexual trauma affect sexual experiences?
People with a history of sexual trauma may be hypervigilant and have a strong startle reaction. Certain triggers may lead to memories or flashbacks, causing them to shut down or emotionally react, including during sex.
“Touch in the present can remind them of the past touch. So, in a second, their brain flashes back to their childhood, triggering dissociation,” Dr. Kapoor says. “They’re not able to differentiate that this touch is a safe and loving touch.”
It can be very helpful for individuals with a history of abuse and their partners to identify such triggers, Dr. Kapoor says. If you are a partner of such an individual, asking questions like, “What kinds of touch trigger you? What body parts seem to lead to distressing reactions?” can help.
“I always tell my patients that there is no definitive cure for it. But how you process the trauma can be helped by learning coping skills and understanding your story,” says Shweta Kapoor, M.D., Ph.D.
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